Healthcare Provider Details

I. General information

NPI: 1720009251
Provider Name (Legal Business Name): DEBORAH A ROSS DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 5TH AVE
HUNTINGTON WV
25701-2207
US

IV. Provider business mailing address

PO BOX 2408
HUNTINGTON WV
25725-2408
US

V. Phone/Fax

Practice location:
  • Phone: 304-525-1901
  • Fax: 304-525-0277
Mailing address:
  • Phone: 304-525-1901
  • Fax: 304-525-0277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number355
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: